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Evaluation for SARS-CoV-2 in Breast Milk From 18 Infected Women

Educational Objective
To understand current evidence about the detection of SARS-CoV-2 in Breast Milk

Concern has been raised that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be transmitted to infants by breastfeeding. A number of organizations advise that women infected with SARS-CoV-2 may choose to breastfeed with protections to prevent transmission of the virus through respiratory droplets. Of 24 case reports on breast milk samples from women infected with SARS-CoV-2, viral RNA was detected in 10 samples from 4 women.16 In some cases, environmental contamination or retrograde flow from an infected infant could not be ruled out. Detection of viral RNA by reverse transcriptase–polymerase chain reaction (RT-PCR) does not equate with infectivity. To date, SARS-CoV-2 has not been isolated from breast milk, and there are no documented cases of transmission of infectious virus to the infant through breast milk. However, potential for viral transmission through breast milk remains a critical question for women infected with SARS-CoV-2 who wish to breastfeed.

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Article Information

Corresponding Author: Christina Chambers, PhD, MPH, University of California, San Diego, 9500 Gilman Dr, MC0828, La Jolla, CA 92093 (chchambers@health.ucsd.edu).

Accepted for Publication: August 3, 2020.

Published Online: August 19, 2020. doi:10.1001/jama.2020.15580

Author Contributions: Drs Chambers and Krogstad had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chambers, Krogstad, Bertrand, Tobin, Bode, Aldrovandi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chambers, Krogstad, Bertrand, Bode.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Chambers, Bertrand.

Obtained funding: Chambers, Bertrand, Bode, Aldrovandi.

Administrative, technical, or material support: Chambers, Krogstad, Bertrand, Contreras, Tobin, Aldrovandi.

Supervision: Chambers, Bertrand, Aldrovandi.

Conflict of Interest Disclosures: Dr Chambers reported receiving grants from the University of California (UC) Office of the President Emergency COVID-19 Research Program and from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences and receiving nonfinancial support from Medela Corporation and the Mothers’ Milk Bank at Austin. Dr Krogstad reported receiving support from the UC Los Angeles AIDS Institute, the James B. Pendleton Charitable Trust, and the McCarthy Family Foundation. Dr Bode reported serving as the UC San Diego Chair of Collaborative Human Milk Research, which is endowed by the Family Larsson-Rosenquist Foundation. Dr Aldrovandi reported receiving support from the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network. No other disclosures were reported.

Funding/Support: The IMPAACT Network is supported by grants UM1AI068632 (Leadership and Operations Center), UM1AI068616 (Statistical and Data Management Center), and UM1AI106716 (Laboratory Center) from the National Institute of Allergy and Infectious Diseases, cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health. Medela Corporation provided milk sample collection materials for this study. The Family Larsson-Rosenquist Foundation provided an unrestricted COVID-19 emergency gift fund. The Mothers’ Milk Bank at Austin, an accredited milk bank and member of the Human Milk Banking Association of North America, paid for shipping costs.

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Additional Contributions: We thank the women who participated in this study and who gave so generously of their time and effort to provide milk samples and clinical information.

References
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Wu  Y , Liu  C , Dong  L ,  et al.  Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding.   BJOG. Published online May 5, 2020. doi:10.1111/1471-0528.16276PubMedGoogle Scholar
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Costa  S , Posteraro  B , Marchetti  S ,  et al.  Excretion of SARS-CoV-2 in human breast milk.   Clin Microbiol Infect. Published online June 2, 2020. doi:10.1016/j.cmi.2020.05.027PubMedGoogle Scholar
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Tam  PCK , Ly  KM , Kernich  ML ,  et al.  Detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human breast milk of a mildly symptomatic patient with coronavirus disease 2019 (COVID-19).   Clin Infect Dis. Published online May 30, 2020. doi:10.1093/cid/ciaa673PubMedGoogle Scholar
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